FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 160

of the leg but is rarely felt in the front or inner portion of the leg. The person frequently
walks with a decided limp. Pain when moving to and from a supine position is also charac-
teristic.
As a result of the pain associated with movement, muscles in the lower back go into
spasm. The vertebral column in the lower back is immobilized and does not bend when
the individual leans to either side, which can be seen when the person is examined from
behind. An examiner's fingers can usually palpate this muscle spasm. Over the foot and
lower leg on the affected side, loss of sensation to pinprick or the light touch of a wisp of
cotton may be present.
Prehospital treatment for sciatica is the same as for strain of back muscles. However,
the two conditions should be differentiated since each has a quite different outlook. Strain
usually clears up in a few days, or perhaps a few weeks, with rest and proper treatment.
Although the pain of sciatica may disappear in a few days with rest, it may be more pro-
longedandmayberelievedonlybysurgery.Furthermore,adiscorbonespurscanproduce
permanent nerve injury and muscle weakness. Even though symptoms of sciatica may dis-
appear rather promptly, a recurrence is likely at any time.
In expedition circumstances, these prognostic factors must be considered. Individuals
withaprevioushistoryofaruptureddiscshouldconsultanorthopedistorneurosurgeonbe-
foreundertakingremotewildernessactivities,particularlyifsensoryimpairmentispresent.
SNOWBOARDING INJURIES
Snowboarding is a rapidly growing winter sport that is gaining acceptance at most ski
areas. Not many studies on injuries have been published, but an investigation of 415 injur-
ies in the Lake Tahoe area has provided significant data.
Those injured were 75 percent males; the average age was twenty years. At least 60
percent were in their first year of snowboarding. Many had never skied before taking up
“boarding.” Falls produced 75 percent of all injuries, mainly to wrists, shoulders, knees,
and ankles. The fracture rate was much higher in snowboarders than in skiers. Wrist frac-
tures were most common. Dislocations of shoulders and elbows also occurred. Ankle
sprains and fractures predominantly befell wearers of soft boots. Those wearing hard-shell
boots more commonly had knee injuries, similar to skiers. However snowboard injuries to
the knees are mainly collateral ligament sprains, not anterior cruciate ligament tears. The
injury rate was slightly lower than that seen in skiers.
Prevention of injuries is directed at learning proper technique, including learning how
to fall with less risk. Pads for elbows and knees and gloves with built-in wrist splints are
available.
In addition, many snowboarders are new to the mountains and must learn to respect the
mountainsinwinter,particularlythesnowpatternsandresidualsofmountainstorms.Many
snowboarders have been killed by falling into tree wells filled with deep powder snow.